MEDICARE: SANG HOON HAN DDS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1649900192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANG HOON HAN DDS INC.

Provider Business Mailing Address
First Line	:	40 GILFEATHER LN
Second Line	:
City	:	KINGSTON
State	:	MA
Zip	:	02364-1876
Country	:	US
Telephone Number	:	909-963-6116
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 N MAIN ST
Second Line	:
City	:	WEST BRIDGEWATER
State	:	MA
Zip	:	02379-1735
Country	:	US
Telephone Number	:	508-583-5338
Fax Number	:	508-583-1398

Authorized Official
Title or Position	:	CEO
Name	:	DR. SANG HOON JOHN HAN
Credential	:	DDS
Telephone Number	:	909-963-6116

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	06/15/2022

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